42-Validation of the Patient Dignity Inventory to Assess Dignity-Related Distress in the Critically Ill
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Patient and Family Support, Behavioral Health and Well Being, 2021
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The Society of Critical Care Medicine's Critical Care Congress features internationally renowned faculty and content sessions highlighting the most up-to-date, evidence-based developments in critical care medicine. This is a presentation from the 2021 Critical Care Congress held virtually from January 31-February 12, 2021.

Blake D. Mergler

Introduction/Hypothesis: Critical illness confers significant risk of psychological distress both during and after intensive care unit (ICU) admission. The Patient Dignity Inventory (PDI) is a 25-item instrument initially designed to measure psychosocial, existential and symptom-related distress in terminally ill patients, and subsequently validated in oncology, palliative care and psychiatry domains. This study was conducted to validate the PDI as a means of identifying distress in inpatient critical care settings.

Methods: We conducted a single-center prospective cohort study of patients admitted to five different ICUs in two hospitals within the University of Pennsylvania Health System from January 2019 to February 2020. The PDI was administered to adult patients admitted to ICUs for greater than 48 hours. To examine the instrument's construct, content and concurrent validity, patients also completed the Patient Health Questionnaire-9, the Generalized Anxiety Disorder-7, and the Health Care Climate Questionnaire. Demographic data and levels of physiologic support at time of interview were abstracted from medical records. The tool's internal structure was assessed via principal components analysis.

Results: 463 patients were eligible to participate during the enrollment period; 155 (33%) participants consented, completed the surveys and were included for analysis. Mean length of ICU admission at the time of interview was 160 hours. Admitting diagnoses included acute hypoxic respiratory failure, traumatic fall, or heart failure requiring heart transplant. Our study demonstrated internal consistency (Cronbach's α = 0.946) of the PDI in critical care settings. Moreover, factor analysis elucidated four themes prevalent in critically-ill patients: illness-related concerns (e.g. 'worry about my future'), interactions with others (e.g. 'not feeling supported by friends and family'), peace of mind (e.g. 'feeling like I am no longer who I was') and dependency (e.g. 'not being able to attend to my bodily functions independently').

Conclusions: This study demonstrates that the PDI can be used to assess patient distress in critical care settings. Further research may elucidate the role of dignity-based interventions in treating and preventing post-intensive care psychological symptoms.


Meta Tag
Content Type Presentation
Knowledge Area Patient and Family Support
Knowledge Area Behavioral Health and Well Being
Knowledge Level Foundational
Knowledge Level Intermediate
Knowledge Level Advanced
Membership Level Select
Tag Mood and Anxiety Disorders
Tag Communication
Year 2021
patient dignity inventory
dignity-related distress
ICU patients
mortality risk


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